Healthcare Provider Details

I. General information

NPI: 1053007153
Provider Name (Legal Business Name): JESSICA MY HOANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 11/02/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 STONERIDGE MALL RD STE 114
PLEASANTON CA
94588-3275
US

IV. Provider business mailing address

5820 STONERIDGE MALL RD STE 114
PLEASANTON CA
94588-3275
US

V. Phone/Fax

Practice location:
  • Phone: 925-421-0393
  • Fax:
Mailing address:
  • Phone: 925-784-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: